In the 18th century scurvy was a big problem for the navy. Nobody knew what caused it but it was a condition that made sailors too ill to work. Various cures were suggested: The Admiralty believed that vinegar was the answer. The Royal College of Physicians disagreed and recommended Sulphuric Acid (presumably very dilute). It was only when James Lind carried out a trial with a group of afflicted sailors that a cure was found. He divided the group randomly into four subgroups and gave each subgroup a different treatment: sulphuric acid, vinegar, lime juice or water.

Only the group given lime juice recovered and eventually this treatment found favour with everyone. Incidentally that is why British sailors got the nickname “limeys”.
The worrying thing is that the people in authority were adamant that their solution was correct, until they were proved wrong. And it begs the question: how many of our current medical practices are wrong and we just don’t know it yet?

This is the topic of the book I am currently reading and the good news is that it is free to read online. The book is called Testing Treatments by Evans, Thornton, Chalmers and Glasziou and you can find it here www.testingtreatments.org

And don’t blame your doctor for not knowing all the answers. The current regulatory system strongly leans against the sort of research that could help us all get better information about what works and what doesn’t when it comes to treating your illness. I strongly recommend this book as a dose of common sense in the confusing world of modern medicine.

We all know that walking is one of the best and safest forms of exercise. It calms the mind, improves circulation and keeps you young. Despite all this…

“I know I should walk more, but it’s boring!” Complained a patient. I sympathised and showed him my latest techie toy. It’s called a SanDisk clip sport mp3 player. It weighs less than some name badges and has a spring clip that you can easily attach to whatever you are wearing. It holds 8Gb of stuff (that’s around 130 hours of music). You can download audiobooks, podcasts and music by plugging it in to your computer. It has a rechargeable battery that refills off a USB socket and lasts for ages. And it has a built in FM radio.

Anyway the patient was duly impressed and next time I saw him he told me he had bought one. I asked him if he had found any good podcasts and he said “no, I can’t be bothered with all that, the radio is enough for me and I can’t believe how good the sound is!”

The good news is that he now feels perfectly happy going out most days for a 30-40-minute walk with the radio for company.

A delightful lady now in her eighties has been visiting me for the past fifteen years every month or so for an osteopathic “top up” and she swears it keeps her agile and flexible. She has little sympathy for her friends, often younger, who grumble about their aches and pains. “Go and see an Osteopath” is her usual advice.

She told me about one of her friends who on receiving this advice admitted to being nervous at being looked at. “Don’t worry my dear”, she replied. “He examines you as if you were a chair”.

Since my original blog post nearly 5 years ago I have been a convert to Kindle. No more heavy books to lug around and strain free reading. I have yet to encounter a repetitive strain injury due to Kindle. It ticks all the boxes.

I have two Kindles, one I bought four and a half years ago the other is a “rescue Kindle”. Neglected and abused, it was picked up and played with on Christmas day by its first owner for half an hour before the novelty wore off.

Although it was loaded up with books it was ignored while the iPad got all the attention. It languished unused and when every three or four weeks I saw the plaintive flash of its flat battery I would pick it up and recharge it until eventually I realised this pattern was not going to change. This was when I decided to adopt. Kindle2 is now part of my techie toy family and seems happy to get exercised nearly every day.

You can deduce from this that I read a lot.

And you may be wondering why am I writing about Kindles on what purports to be an osteopathic blog?

Well it’s that… while I am treating patients we often chat and the conversation often turns to books.

As an experiment I decided to include on my blog, the titles of the books I am currently reading on my pair of Kindles. If nobody is interested, or if I get bored with the experiment…no harm done!

In progress on Kindle1 is “Letters from a Stoic” by Seneca (Penguin Classics – Robert Campbell translation 1969). This is a serious read, a philosophy that sets down guidelines for a more cheerful and appreciative existence. By deliberately contemplating the worst things that life could throw at you your expectations are reset to such a low level that normal events become pleasant surprises and you live more “in the moment”. I am taking this collection one letter at a time.

Just finished on Kindle2 is “The Rebels of Ireland, The Dublin Saga by Edward Rutherfurd. My third consecutive read from this author. First of all I read “London” a series of hops and skips from pre-Roman to almost current time, following loosely the genetic lines of individuals who shaped and were affected by the history of their times. Along the narrative there are snippets of fascinating facts such as: Scotland Yard used to be where visiting dignitaries from Scotland stayed when visiting Court in London.

I followed up with “New York” and saw elements of the same time line from the American perspective and how the two narratives intertwined more and more as the transport links became stronger. Again we ended within five years of the present.

“The Rebels of Ireland” opened my eyes to Irish history; we didn’t get this stuff at school! Against the backdrop of the previous two books I got some appreciation of the power struggles and influences of England, America and France on Irish history. This author has written more books each based on a place and a time line. He is on my list but I feel the need for a change of genre.

That’s how it seems with NICE guidelines. If your hospital appointment or treatment is outside of the recommended waiting time and you dare to complain the official line is “well they are only guidelines”.

On the other hand if you request a procedure or test that is out of the ordinary you are liable to be told that what you want doesn’t have NICE approval.

So when I read that NICE approve osteopathy for low back pain, forgive me for yawning and thinking “so what” before turning the page.

Note: [NICE stands for The National Institute for Health and Care Excellence. It is an independent organisation and was set up by the Government in 1999. NICE decides which drugs and treatments are available on the NHS]

“This is the Institute of Osteopathy”, said the voice on the phone. Expecting the worst I was instantly cautious.

“Do you remember the survey you filled in a few weeks ago?” Um, yes I vaguely remembered; trying desperately to remember what I had written (and wasn’t it supposed to be anonymous).
“Do you remember the box you ticked at the end, to enter the draw?” Yes, I always tick the box.
“Congratulations, you have won an iPad mini!”

I was astonished. That last time I won a prize draw I was four years old; (it was a compendium of games from Will, Wag and the Ducklings, do they still appear in People’s Friend magazine?).

Fast forward two weeks and today I was delighted to have a visit from Maurice Cheng and Nik Watson bearing gifts. As well as the iPad there was a bottle of champagne, both gratefully received. After coffee, a brief chat and a few photos they were off to their next destination while, excitement over, I went back to work.

Knee problems keep surgeons busy. Around 80,000 knee operations are carried out by the NHS in the UK every year and a lot of them are triggered by overuse and repetitive movements. If you hurt your knee playing sport you can probably afford time off for recovery but if your livelihood depends on being able to kneel you are in trouble. Electricians, plumbers, decorators and carpet fitters probably spent more time kneeling than standing some days. The obvious risk is kneeling on something hard and sharp, a fragment of concrete or metal or an uneven surface with raised edges. The less obvious risk is prolonged pressure which can interfere with blood circulation and can cause bursitis; a painful inflammation that accounts for 20% of the compensation claims in knee overuse injuries.

Here is photo of a knee with a prepatellar bursitis caused by kneeling on a rough surface. This condition used to be called “housemaids knee”

As an osteopath I see quite a few "dodgy knees". Once the damage is done I can help reduce the pain but I can’t restore your knee once arthritis has permanently changed its shape. My advice is to protect your knees by using good quality knee pads while you are working.

Be wary of foam based products which can deform fairly quickly; I prefer something like "Redbacks" whose knee pads are designed to spring back into shape every time they are deformed and will give better protection

I was squirming a bit during the interview. “What do you do?”
Me “I’m an osteopath”
“What do you treat?”
Me “all sorts of things”
“Can you be more specific?”

Then we moved on to easier subjects. Some history and context, and my views on continual training. And then there was a photo of me working. It had to look right, nothing scary or taken from a strange angle and it mustn’t look posed.

Give me a bad back or a neck and shoulder problem any day of the week, this interviewing stuff is hard work and well outside my comfort zone, but we got there in the end. Here is the final article that appeared in the business section of the Kentish Express today. What do think of it?

It seems to me that every day is a national awareness day for one thing or another. It was only when I discovered this website www.national-awareness-days.com that I realised the scale of the problem. Here is the list for February, and there may be more:

Acupuncture Awareness Week

Bramley Apple Week

British Yorkshire Pudding Day

CC Awareness Month

Children Of Alcoholics Week

Day For Change

Eating Disorders Awareness Week

Fairtrade Fortnight

Go Green Week

Gold Heart Day

International Mother Language Day

Marriage Week

National Chip Week

National Doodle Day

National Heart Month

National Nest Box Week

National Wear Red Day

Rare Disease Day

Raynauds Awareness Month

Safer Internet Day

Student Volunteering Week

Think About Sex Day

Tinnitus Awareness Week

University Mental Health and Wellbeing Day

Work Your Proper Hours Day

World Cancer Day

World Thinking Day

World Wetlands Day

Surely by having so many awareness campaigns the effect is diluted to be almost negligible. Does anyone take these things seriously any more? Even when I used to see national osteopathy week mentioned I had to stifle the urge to yawn, although a few years ago something happened that made me take a bit more notice: a colleague wrote a rather personal and explicit letter to the lady in his life that ended with the line “I want you NOW”. Then he accidentally hit “reply to all” and emailed it to everyone on the mailbase. Shortly afterwards he sent an apology to everyone expressing his regret and embarrassment at what had happened. Only one person replied, to say that he assumed NOW was an acronym for National Osteopathy Week.

So please excuse me if you see a little smile whenever National Osteopathy Week is mentioned.

I was chatting to a patient this morning and we gradually realised how similar our work patterns are. He is a plumber and his clients tend to fall into three discrete groups: emergencies, upgrades and maintenance. His maintenance clients tend to be those with boilers that need a clean and a once over every year. Mine are the individuals who like to keep their bodies flexible and feeling comfortable and they come along for a "loosen up" every three to eight weeks (it varies a lot). His upgrades are the clients who decide to have a new kitchen or bathroom because the old one is tired, or dysfunctional or no longer to their taste. My "upgrades" tend to be the patients who have come to realise that they creak and ache and are seizing up. Typically they get a shock when an old easy activity suddenly hurts, like turning to look right at a junction when driving. Or discovering that you don’t turn your head any more, you turn your whole body. And then we both have the emergencies. Sometimes they are due to lack of maintenance but other times things just happen. Sport, gardening and falling, twisting, lifting injuries are responsible for most of my emergencies. Most plumbing emergencies are when things stop working; like central heating systems. The only difference I suppose is that you can replace your entire plumbing system if necessary. Unfortunately you only get one body.